Dr. Ashutosh Chandan Dubey (Internal Medicine) needs a second opinion on this medical case.
Motor Neuropathy of Left Median Nerve leading to wasting of small Ms of left hand.
A 18 yr old complaining of weakness of lt hand for past 7 months. Initially it started with tremors followed by weakness. He is unable to grasp, adduct, abduct or hold objects or make a fist.
The weakness is gradual n progressive and assymetric with wasting of thenar, hypothenar and other intrinsic ms of left hand. Wrist joint, elbow n shoulder joint movement n power are normal in b/l upper limb. No visible fasciculations.
Jerks are normal. No cerebellar , sensory, cranial Nv abnormality.
No significant past history or family history.
O/E pt is normotensive, no H/O trauma,loc,,cva,DM,thyroid disorder, paresthesisas, Hansen disease or other causes of neuropathy.
One small nodule was seen on abdomen most likely to be neurofibroma.
Rest examinations are normal.
No H/O neck pain etc.
According to me D/D motor neuropathy,MND.. Or compressive myelopathy due to neurofibroma.
Has sent pt for MRI Cervical spine and NCV and other examinations.
His MRI cervical spine is normal while NCS is suggestive of Motor neuropathy of left Median nerve.